目的:嗅沟脑膜瘤(OGMs)通常需要手术切除。最近锁孔方法的引入提出了一个问题,即是否可以通过较小的颅骨开口更好地治疗这些肿瘤。一种这样的方法,眶上锁孔开颅术,在结果方面,从未与更传统的开放式经颅方法进行比较。在这项研究中,作者比较了临床,射线照相,眼眶锁孔入路(SOA)和传统经颅入路(TTA)之间的功能生活质量(QOL)结果。他们试图在相对病例匹配的系列患者中研究开放/TTA与锁孔SOA在OGM切除术中的潜在优缺点。
方法:回顾性研究,对57例接受锁孔SOA或更大的传统经颅(额颞叶,翼点,在2005年至2023年之间对新诊断的OGM进行了开颅手术。切除程度,嗅觉,停留时间(LOS)术后血管源性和细胞毒性水肿的影像学体积评估,和QOL(使用前颅骨基础问卷)进行评估。
结果:包括32例SOA和25例TTA患者。平均EOR通过方法没有显着差异(TTA:99.1%,SOA:98.4%,p=0.91)。嗅觉以相似的比率得到保留或改善(TTA:47%,SOA:43%,p=0.99)。SOA患者的平均LOS(4.1±2.8天)明显短于TTA患者(9.4±11.2天)(p=0.002)。作者发现术后FLAIR脑水肿的增加与TTA之间存在关联(p=0.031)。最后一次随访时ASQB评估的QOL在组间没有显着差异(p=0.74)。
结论:与传统开放入路相比,锁孔SOA与LOS的统计学显著降低和术后水肿较少相关。
OBJECTIVE: Olfactory groove meningiomas (OGMs) often require surgical removal. The introduction of recent keyhole approaches raises the question of whether these tumors may be better treated through a smaller cranial opening. One such approach, the supraorbital keyhole craniotomy, has never been compared with more traditional open transcranial approaches with regard to outcome. In this study, the authors compared clinical, radiographic, and functional quality of life (QOL) outcomes between the keyhole supraorbital approach (SOA) and traditional transcranial approach (TTA) for OGMs. They sought to examine the potential advantages and disadvantages of open/TTA versus keyhole SOA for the resection of OGMs in a relatively case-matched series of patients.
METHODS: A retrospective, single-institution review of 57 patients undergoing a keyhole SOA or larger traditional transcranial (frontotemporal, pterional, or bifrontal) craniotomy for newly diagnosed OGMs between 2005 and 2023 was performed. Extent of resection, olfaction, length of stay (LOS), radiographic volumetric assessment of postoperative vasogenic and cytotoxic edema, and QOL (using the Anterior Skull Base Questionnaire) were assessed.
RESULTS: Thirty-two SOA and 25 TTA patients were included. The mean EOR was not significantly different by approach (TTA: 99.1% vs SOA: 98.4%, p = 0.91). Olfaction was preserved or improved at similar rates (TTA: 47% vs SOA: 43%, p = 0.99). The mean LOS was significantly shorter for SOA patients (4.1 ± 2.8 days) than for TTA patients (9.4 ± 11.2 days) (p = 0.002). The authors found an association between an increase in postoperative FLAIR cerebral edema and TTA (p = 0.031). QOL as assessed by the ASQB at last follow-up did not differ significantly between groups (p = 0.74).
CONCLUSIONS: The keyhole SOA was associated with a statistically significant decrease in LOS and less postoperative edema relative to traditional open approaches.